The use of diuretics in preventing ascites recurrence

A double-blind study was carried out in 39 cirrhotic outpatients with chronic recurrent ascites. After the ascites was cleared, 19 of these patients were put on spironolactone maintenance treatment and 20 on K-canrenoate. Drug doses were tailored individually according to the clinical status of the patient. During 12 months follow-up, 18 patients remained free of ascites, 13 experienced one or more recurrence easily managed by adjusting the drug dosages and eight developed diuretic-resistant ascites. The two anti-aldosterone drugs were equally effective in the long term prevention of fluid reaccumulation. Mean plasma values of sodium, potassium, prolactin, testosterone and 17 beta-oestradiol were unaffected by the drugs. In contrast, gynaecomastia occurred in 25 per cent of patients receiving K-canrenoate and in 40 per cent of those on spironolactone. Gynaecomastia showed a time-related increase in the spironolactone group but not in the K-canrenoate group. At the doses employed, no dose-relationship was found between gynaecomastia and drug treatment. The study shows that, in the long term prevention of ascites, low doses (100 mg daily or 100 mg every other day) of both anti-aldosterone drugs are safe and effective but oestrogenic side effects are less frequently observed with K-canrenoate therapy.